Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CH8636 | FL |
NPI | 1598063505 |
---|---|
Provider Name | Dr. Joleene Anderson |
First Address | Winter Haven, FL 33880 |
Second Address | Winter Haven, FL 33880 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2011 |
Last Update Date | 12/09/2013 |